Cyclical vomiting syndrome

What is cyclical vomiting syndrome?

Cyclical vomiting syndrome is a condition in which a person has repeated episodes of feeling sick (nausea), being sick (vomiting) and also feeling exhausted. In between these episodes they will feel completely well.

Who develops cyclical vomiting syndrome?

The exact number of people with cyclical vomiting syndrome is not known. It is a rare condition and some experts state it affects around 3 in 100,000 children, although it is thought to be more common than this. It is more common in childhood, although adults can also have this condition. It most commonly starts around the age of 5 years and it is more common in girls than in boys.

It is also more common in those people who also have migraines. There is actually an overlap between this condition and abdominal migraine. It can also run in some families.

What are the symptoms of cyclical vomiting syndrome?

The main symptoms of cyclical vomiting syndrome are suddenly feeling very sick (nausea) and then being sick (vomiting). It also causes you to feel extremely tired. These symptoms can last for a few hours to even a few days. These episodes can be so severe that you may have to have time off school or work.

Other symptoms may include looking pale, tummy (abdominal) pain, runny stools (diarrhoea) and a headache. You may notice that you are more sensitive than usual to light and noise.

There are four phases of this condition:

• Prodromal phase - you may have severe sweating and feel very sick. You may look very pale.

• Vomiting phase - when vomiting starts it is often very severe. You may even be sick five to six times an hour. Other symptoms such as those listed above may also occur.

• Recovery phase - the nausea and vomiting stop and you start to feel better.

• Well phase - this is the last phase in which you feel completely well again. This can last for several days, weeks or months.

Many people find that their symptoms usually last for the same length of time each episode.

Note: it is important to see your doctor straightaway if you have any symptoms or signs of a severe lack of fluid in the body (dehydration). These may include having dark-coloured urine, not passing urine very often or having a very dry mouth and dry skin.

What causes cyclical vomiting syndrome?

The actual cause of cyclical vomiting syndrome is not known. Sometimes an event or condition can trigger an episode. Examples of these include:

• Stress.

• Anxiety.

• Infections.

• Certain foods (for example, chocolate or cheese).

• Having long periods of time without food or drink.

• Being in hot weather.

• Menstrual periods in some women.

• Doing too much exercise.

• Not having enough sleep.

How is cyclical vomiting syndrome diagnosed?

There is no specific test for cyclical vomiting syndrome. The diagnosis is made from your symptoms. It is important sometimes for your doctor to exclude any other cause for these symptoms. For this reason, some people need to have further investigations or tests.

In children, this condition is often suspected when:

• There have been five or more episodes ever or there have been at least three episodes in the previous six months.

• The episodes of being sick (vomiting) last between one hour and ten days and are at least one week apart.

• These vomiting episodes occur at least four times an hour for at least one hour.

• The child is completely well in between these episodes.

In adults, this condition is suspected when you have had three or more vomiting episodes in the previous year which have been very similar in nature.

Further investigations may include blood and urine tests. An ultrasound scan or a gastroscopy may be undertaken for some people. A gastroscopy is a test in which a thin, flexible telescope is passed down your gullet (oesophagus) into your stomach.

What are the treatment options for cyclical vomiting syndrome?

The treatment depends on the frequency and severity of your symptoms. If you have any warning that an episode is going to start, in the prodromal phase, it can be very useful to take treatment early to prevent an episode actually occurring.

Commonly a combination of medication is given. Medicine that helps to reduce feeling sick (nausea) and being sick (vomiting) and painkillers are often given. Sometimes certain medicines that are used for treating migraines can work really well.

If the nausea and vomiting are very severe and you also become lacking in fluid in the body (dehydrated), you may need to be treated in hospital. Fluids and also medicines can be given via a drip directly into one of your veins until you start to feel better.

Preventing cyclical vomiting syndrome episodes

It is very important to try to recognise any triggers and then to avoid them, if possible.

For example, ensure you eat food at regular intervals and also drink fluids regularly to prevent becoming lacking in fluid in the body (dehydrated). If you are under any stress or have any anxiety then it is often worthwhile exploring treatments for these. See separate leaflets called Anxiety and Stress and Tips on How to Avoid It for more details.

Some people take medicines which are also given to prevent migraines occurring and they can work really well for some people.